Every time I read a story about the death of a baby from a disease that already seemed controlled, I get bad. And worse when we talk about a disease that increases when vaccination coverage decreases. In this case, that of the whooping coughWe cannot blame all the vaccines because it is a disease that is also increasing in the form of contagious outbreaks in areas that have the majority of children vaccinated.
And it had to happen, and it will continue to happen. Whooping cough has been increasing in industrialized countries for a few years and young babies are the ones who have to lose it, because the severity at an early age can be high, to the point of leading to death. It is what has happened in Alicante, where one month old baby has died from whooping cough.
The baby was not vaccinated yet
The pertussis vaccine, as we told you in its day, is part of the hexavalent vaccine (together with tetanus, diphtheria, hepatitis B, etc.) and is given to babies at 2 months of life. It is a vaccine that produces very limited protection and must be re-administered at 4 and 6 months, again at 18 months and again at 4-6 years (this dose was added in 2001).
With all these doses it was considered that the disease could be controlled. However, seen data from other countries, where whooping cough has been increasing for years, and seen from Spain, where we have gone from one case per 100,000 inhabitants to 6 per 100,000 since 2010, it is clear that the thing is getting worse. They do not seem many, but if we think that where I live, that we are 200,000 inhabitants, we will have 12 cases per year and that it is estimated that almost half of them are infants, we have 6 babies in my city suffer from pertussis every year, with risk that this entails (if we extend it to the Spanish state, about 1,400 affected babies leave each year).
Going back to the baby, for now no more cases have been diagnosed, although whooping cough has an incubation time and you have to wait for the next few days to know if it is an isolated case or if we are facing a possible outbreak of the disease. Obviously, from the hospital, they have looked for anyone who had been in contact with the baby in the last days to administer the vaccine and / or give them a preventive antibiotic.
Why pertussis is returning
As I said, in 2001 a fifth dose of pertussis was added in children aged 4 to 6 years. With this fifth dose it was estimated that the protection would be correct. The problem is that the coverage of the fifth dose does not exceed 83%. But we cannot be left alone with this data, since most pertussis infections are usually caused by adults. The pertussis vaccine has limited protection over time and adolescents and adults appear to be exposed to the disease more than previously thought. That is why the AEP has been recommending that tetanus and diphtheria vaccine aged 11-12 years also carry a portion of whooping cough. This way teenagers will be protected again. And that is why we should assess the possibility of administering a dose of memory to adults, together with those of tetanus.
And infants who have not been vaccinated?
Babies who have not received any vaccine, and even those who carry only one dose, are at risk. Being adults who can spread the disease, the nest strategy could be done (vaccinate all adults who will be in contact with the baby) and / or vaccinate the mother, during pregnancy, so that the child is born with protection, which is what is being done in the United Kingdom, where in 2012 there were 12 deaths of babies from whooping cough, for being the most economical solution and the one that produces the best results. In Catalonia, for a few months, it is also being done.
Summarizing
So, in summary, whooping cough has caught us all off guard. What was considered to be the best strategy has proven not to be and the five doses in childhood seem to be insufficient. Now the autonomous communities and the state will have to start assessing what strategies to take to protect the population, both adults and toddlers, who are the ones with the worst. And the question is to start vaccinating pertussis to more groups: to pregnant women, sure, since it is a solution that is working, but also to adolescents and, if it can be, if money arrives, to adults. No one wants to see any baby die from a disease that can be prevented.
